Can you tell us a bit about the Elective Care Respiratory Pathways programme in relation to its focus on scaling breathlessness pathways in primary and secondary care. Please explain how you are working to achieve reduced waiting times, and better outcomes for patients with breathlessness?
Following multiple expression of interest submissions, ten Integrated Care Boards (ICBs) were shortlisted in 2025 to begin, or continue, developing chronic breathlessness diagnostic pathways in their area.
As clinical lead of this programme, I worked with Graham Finney and David Linden from Health Innovation Yorkshire & Humber to support these ICBs.
Support was provided through small professionally led or community-based groups, and 1:1’s which helped the ICBs write business cases, engage with local stakeholders, launch and develop existing pathways.
We focussed on areas without Community Diagnostic Centres and encouraged the use of the NHSE pre-diagnosis breathlessness pathway to review their existing pathways, or how to structure new pathways, and explore how exiting pathways could be improved to provide quicker diagnosis and more efficient management processes for patients.
Alongside improvements to patient care – what other outcomes are you hoping to achieve as part of the project?
Across the UK, 5% of all Emergency Department attendances are due to breathlessness. Our aim is that diagnostic breathlessness pathways will support the reduction of Emergency Department attendances through earlier diagnosis and therefore better and more timely management.
These pathways will enable secondary care to focus on other specialist areas and improve their Referral to Treatment (RTT) time. Having diagnostics in one place will reduce travel for patients, support primary care diagnostic gaps, reduce fragmentation in pathways and help tackle health inequalities.
The diagnostic pathways will reduce repeated appointments and improve patient confidence and experience. Through ICBs we will improve engagement and communication locally and nationally across primary and secondary care and other areas providing pathways to improve services.
Additionally, there is an ongoing project which is looking at developing neighbourhood pathways for breathlessness and cough. (‘Neighbourhood health’ is the term used to describe the national drive to move from care delivered in hospitals; to care delivered in the community). The aim of this project is to improve how and when chronic breathlessness and cough is identified and diagnosis within the community.
For our audience who may want to implement some of these changes in their own trusts, what resources are currently available to support that?
The pre-diagnosis breathlessness pathway, which was developed at a national level, is available on the NHS intranet outlining the suggested pathway and what investigations are needed and where.
We are currently finalising a chronic breathlessness pathway implementation toolkit that, when ready, will be available on the Health Innovation Oxford & Thames Valley website. The toolkit will support the development of breathlessness diagnostic pathways and will outline the importance of needing a breathlessness pathway. It will provide resources to support the understanding of localised requirements, designing pathways, workforce needs, and will signpost to resources and case studies.
In year two of this work, we will be hosting webinars and face to face meetings for areas wanting to develop breathlessness diagnostic pathways and will be providing - more resources – known as Action Learning Sets – and small professionally-led or community-based groups for areas to share and support each other in the development of these pathways.
Find out more about the Elective Care Respiratory Pathways programme and access resources to support the development and implementation of breathlessness, sleep and chronic cough pathways.